Why is giving birth so expensive in the US? Well, it largely comes down to supply.
There’s a significant shortage of obstetric care in many areas, particularly outside of major urban centers. Currently, more than one-third of the country lacks a hospital birth unit or any obstetric provider. It’s no surprise that the US is facing alarmingly high maternal mortality rates.
Clearly, America has to step up its game for mothers and their babies. Fortunately, the solution is relatively straightforward. We could see emergency care clinics and outpatient surgical centers introducing independent birth centers. This could help increase access to safe maternal care, lower medical costs, and enhance overall outcomes.
Birth centers have established successful models of care. These independent facilities often have midwives and doctors specializing in low-risk births outside traditional hospitals. Evidence shows that women choosing to give birth in these centers face fewer medical interventions; resulting in strong health outcomes. Healthy women giving birth in these centers tend to have outcomes comparable to those of hospital births without the heightened risk.
Still, the reality is that independent birth centers must navigate complex regulations, which presents significant challenges. Different states impose various regulatory frameworks, and many restrict the health services provided, even outright banning certain necessary services. For instance, some birth centers cannot perform basic surgical interventions. This means that in emergencies, women may have to be transferred to distant hospitals, if those hospitals are open at all.
Allowing outpatient surgical and emergency care centers to establish and operate birth centers could make a positive difference. These care facilities are widely available, especially in rural areas where they serve as vital healthcare resources. Outpatient surgical centers are already facing certain restrictions while maintaining surgical procedures. Implementing dual licensing could turn these centers into lifelines for maternal and neonatal care.
Unfortunately, current federal regulations hinder this dual-purpose model. The Centers for Medicare and Medicaid Services have placed conditions on coverage that effectively limit dual functionality.
For instance, CMS.gov states: “[Ambulatory Surgical Center] other entities, such as the ASC or adjacent physician’s office, aren’t allowed to combine functions in shared spaces at the same time.” While these regulations aim to safeguard patient health, not permitting birth centers to collaborate with emergency care facilities restricts critical access for at-risk mothers and ultimately affects overall maternal health outcomes across the nation.
This isn’t about cutting corners; it’s really about amplifying the focus on results. Outpatient surgery centers already adhere to stringent regulations regarding safety, staffing, and equipment. Emergency care facilities also undergo rigorous oversight. Even when these facilities want to create a birth suite, they must comply with both sets of regulations. The only difference would be the availability of obstetric services.
Likewise, dual licensing could help reduce healthcare expenses. Delivering babies in birth centers can save around $5,000 compared to similar hospital births, decreasing unnecessary interventions and extended hospital stays. Providing birth options through centers can also free up vital hospital resources for more urgent cases.
Implementing a dual licensing framework does not mean shifting all births to hospitals or birth centers. However, just because hospitals are essential doesn’t mean they are the only option available. To enhance maternal healthcare in the U.S., a flexible system is necessary—one that meets real needs. This ensures geography doesn’t dictate whether women receive professional support during such pivotal life moments.
None of this is achievable without federal backing. The federal government’s influence on state and local health policies is immense, and the existing regulatory environment essentially prohibits dual licensing. However, there’s reason for optimism—a straightforward change at the federal level could save countless lives and dollars annually.
Maternal health in the U.S. stands at a critical juncture. Policymakers must leverage existing resources and seek sensible, targeted reforms to benefit families. Allowing outpatient surgery centers and emergency care clinics to operate birth centers is an obvious and effective step. It’s cost-efficient and could save lives.
It’s time to revise our regulations. Doing so signals a commitment to the health of American mothers and their babies.
